Endometrial & Cervical Polyps

Introduction

A polyp is a small lump or nodule that grows in some parts of the body. What defines a polyp is that it grows away from the organ where it originates from, usually on a small pedicle or stalk. Nodules on the other hand tend to grow within the organ where they originate. Cysts are particular types of nodules filled with fluid.

An endometrial polyp as the name says originates from the endometrium, the tissue present inside the uterus. Endometrial polyps grow inside the uterine cavity. A cervical polyp grows from the epithelial cells of the cervix and usually can be seen outside the uterus at the tip of the cervix.

Symptoms

Sometimes polyps cause symptoms. These are usually irregular bleeding in women who still have periods and new bleeding in women who are already in menopause. Sometimes polyps do not cause any symptoms and women are unaware of their presence. Cervical polyps are sometimes seen by the doctor during a Pap Smear, endometrial polyps can be seen on ultrasound.

Diagnosis

Most polyps can be seen on ultrasound and that is usually the first test done on women who experience abnormal bleeding. Sometimes a hysterosonogram may be required. This is a particular type of ultrasound where a special fluid is squirted inside the uterine cavity. This adds contrast helping delineate the polyp thus increasing its visualisation on ultrasound. The definitive diagnosis is made through direct visualisation with a hysteroscope. A hysteroscope is an optical instrument attached to a camera. It is inserted inside the uterus through the cervix providing direct vision of the uterine cavity and the polyp. The hysteroscope is also used to surgically remove the polyp. (please refer to the hysteroscopy explanation for more information).

Treatment

Symptomatic polyps, i.e. polyps that cause bleeding, or discharge need to be removed for resolution of the symptoms and asymptomatic polyps usually need to be removed to exclude the possibility of cancer.

The removal of endometrial or cervical polyps is a relatively simple procedure.

Some cervical polyps are completely seen outside the cervix and can be removed in a doctor’s office or surgery with an instrument called a polyp forceps. Endometrial polyps and deeply positioned cervical polyps require a hysteroscopy. Polyps are then removed under direct vision with special hysteroscopic surgical instruments. Small polyps can be removed as outpatient procedures with local anaesthesia. Larger polyps may require a general anaesthetic. One way or the other, there are no cuts or surgical incisions, no significant post-operative pain and the recovery is immediate.

Frequently Asked Questions

Why do polyps grow?

Any growth in our bodies, from simple things like skin moles, breast nodules and ovarian cysts to more serious conditions such as cancers, happens when one particular cell multiples itself more than it should creating an extra mass of cells where there shouldn't be one. It can be seen as a small defect in the mechanisms that control cell multiplication in the body.

What is the difference between benign and malignant growths?

A benign nodule, cyst or polyp is usually limited, meaning first that it eventually stops growing and second that it doesn't spread to other areas. A malignant growth, also known as cancer, never stops growing. If untreated, it spreads to nearby organs and eventually can send metastasis to distant parts of the body.

Are endometrial and cervical polyps dangerous?

The vast majority of endometrial and cervical polyps are benign, meaning that they do not cause any harm other than simple symptoms such as vaginal bleeding and mild cramps. A small number of polyps, in the order of 1 to 3 %, can be malignant and develop into cancer.

Can polyps come back?

Polyps that have been removed do not come back. There is a possibility that new polyps will grow in the future.

What if my polyp is malignant?

In a small number of cases (1 to 3%) pathology will show that the polyp is malignant. In this case more treatment may be required. This may be in the form of more investigations such as a hysteroscopy for further curettings, medication and, in a small number of cases, a hysterectomy.